Accountants
Advice Line
1300 464 989
1
2
3
4
5
6
Accountants
Advice Line
1300 464 989
1
2
3
4
5
6
Completing this online Proposal Form
Please answer all questions giving full and complete answers.
It is the duty of the proposer to provide all information that is requested in this Proposal Form as well as to disclose relevant facts. A relevant fact is a known fact or circumstances that may influence the evaluation of risk by the insurer. If you are uncertain about what a relevant fact is, please contact us.
If renewing an existing policy with Express Insurance, please ensure you check all information and make any necessary changes.
Business Details
Income Details
Total Annual Income
$
Employee Numbers
Do you employ staff (excluding yourself)?
Yes
No
Please state the total number of staff including yourself:
Business Activity Analysis
Total must be 100%:
Accounts Preparation, Bookkeeping & Management Accounting
%
Forensic Accounting
%
Taxation
%
IT Consultancy
%
Audit Publicly Listed Companies
%
Insolvencies/Liquidations/Receiverships
%
Audit Financial Institutions
%
Management Consultancy (excluding M&A)
%
Audit Not For Profits/Charities
%
Corporate Advisory - Publicly Listed Companies
%
Audit Private Companies
%
Corporate Advisory - Financial Institutions
%
Audit Self Managed Super Funds
%
Migration Services
%
Business Valuations
%
SMSF Administration (no financial advice)
%
Company Secretarial/Registrar Services
%
SMSF Advice under a Limited AFSL
%
Financial Planning/Investment Advice
%
Executorships/Trusteeships
%
Mortgage/Finance Broking
%
NDIS Plan Management (Accounting services only)
%
Yes
No
In the past have you performed any other accounting activities not declared above for which you require cover?
Please provide details of other activities:
Have you continuously held Professional Indemnity Insurance covering these activities?
In respect of Total Annual Income, please provide a breakdown by State:
Total must be 100%:
NSW
ACT
QLD
VIC
TAS
SA
WA
NT
Overseas
Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?
Yes
No
Period of Insurance
Policy Start Date
Promotional Code (if relevant)
